Two Doctors Receive Awards for Excellence

The Lupus Insight Prize

Mark J. Shlomchik, MD, PhD,incoming Chair of Immunology at the University of Pittsburgh, has been named the first recipient of the prestigious Lupus Insight Prize.

The prize will allow Dr. Shlomchik to continue to investigate the connection between the death of neutrophils, the body’s most abundant white blood cells, and lupus.

The ALR awards the Lupus Insight Prize — in collaboration with the Lupus Foundation of America and the Lupus Research Institute — to recognize and honor exceptional investigators each year.

The NIH Merit Award

George Tsokos, MD,Chief of the Division of Rheumatology at Beth Israel Deaconess Medical Center and Professor of Medicine at Harvard Medical School, recently received the NIH MERIT award recognizing his longstanding scientific contributions to lupus research.

This award will help further Dr. Tsokos’s work to characterize biochemical and molecular events to improve the function of the immune system for lupus patients.

Selected as awardees, Dr. Shlomchik and Dr. Tsokos have already demonstrated a record of creativity, innovation, and productivity. They are outstanding scientists, even in the rarified environment of lupus research.

Vasculitis

Vasculitis is a condition that involves inflammation in the blood vessels. The condition occurs if your immune system attacks your blood vessels by mistake. This may happen as the result of an infection, a medicine, or another disease or condition.

Vasculitis can affect any of the body's blood vessels. These include arteries, veins, and capillaries. Arteries carry blood from your heart to your body's organs. Veins carry blood from your organs and limbs back to your heart. Capillaries connect the small arteries and veins.

Urinalysis

Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through the urine. Urinalysis may be used to test kidney function and health.

Uremia

Uremia is a term used to loosely describe the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ.This is not to be confused with uricemia, or hyperuricemia, a build up of uric acid in the blood.

In kidney failure, urea and other waste products, which are normally excreted into the urine, are retained in the blood. Early symptoms include anorexia and lethargy, and late symptoms can include decreased mental acuity and coma. Other symptoms include fatigue, nausea, vomiting, cold, bone pain, itch, shortness of breath, and seizures. It is usually diagnosed in kidney dialysis patients when the glomerular filtration rate, a measure of kidney function, is below 50% of normal.

Undifferentiated connective tissue diseases

The term undifferentiated connective tissue diseases is used to define conditions characterized by the presence of signs and symptoms suggestive of a systemic autoimmune disease that do not satisfy the classificative criteria for defined connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), rheumatoid arthritis (RA) and others. A small percentage of patients presenting with an undifferentiated profile will develop during the first year follow up of a full blown CTD, however an average of 75% will maintain an undifferentiated clinical course. These patients may be defined as having a stable undifferentiated connective tissue diseases (UCTD). The most characteristic symptoms of UCTD are represented by arthritis and arthralgias, Raynaud's phenomenon, leukopenia, while neurological and kidney involvement are virtually absent. Eighty percent of these patients have a single autoantibody specificity, more frequently anti-Ro and anti-RNP antibodies. Stable UCTD are considered as distinct clinical entities and therefore it has been proposed to define those conditions as UCTD. Classificative criteria have also been proposed and a work to better define them is still under way.

Tregs

Playing a unique role in the immune system, Tregs — or Regulatory T cells — are crucial in suppressing aberrant pathological immune responses in autoimmune diseases like lupus. These cells help the immune system from attacking healthy tissue.

Acting as a system of checks and balances, Tregs prevent excessive reactions within the body.

Transcription factors

Transcription factors are proteins involved in the process of converting, or transcribing, DNA into RNA. Transcription factors include a wide number of proteins, excluding RNA polymerase, that initiate and regulate the transcription of genes. One distinct feature of transcription factors is that they have DNA-binding domains that give them the ability to bind to specific sequences of DNA called enhancer or promoter sequences. Some transcription factors bind to a DNA promoter sequence near the transcription start site and help form the transcription initiation complex. Other transcription factors bind to regulatory sequences, such as enhancer sequences, and can either stimulate or repress transcription of the related gene. These regulatory sequences can be thousands of base pairs upstream or downstream from the gene being transcribed. Regulation of transcription is the most common form of gene control. The action of transcription factors allows for unique expression of each gene in different cell types and during development.

Total Joint Replacement

An arthritic or damaged joint is removed and replaced with an artificial joint, called a prosthesis. The goal is to relieve the pain in the joint caused by the damage done to the cartilage. The pain may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint. A physical examination, and possibly some laboratory tests and X-rays, will show the extent of damage to the joint. Total joint replacement will be considered if other treatment options will not relieve the pain and disability.

Toll-Like Receptors

Toll- like receptors (TLR) play a critical role in early immune response to invading pathogens. The signaling by TLRs result in a variety of cellular responses including the production of interferons and pro-inflammatory cytokines that direct immune response.

Tolerogenic dendritic cells

Discovered just 35 years ago, dendritic cells are profoundly changing the science of immunology. While the precise role of dendritic cells in lupus is not yet known, we do know they are antigen-presenting cells that both control and curtail immunity. Dendritic cells are divided into two main subsets.

Mature dendritic cells are immunogenic. They patrol the body seeking out foreign invaders, whether these are bacteria, viruses, or dangerous toxins. After capturing the invaders, often termed antigens, dendritic cells convert them into smaller pieces and display the antigenic fragments on their cell surfaces. The dendritic cells then travel to lymph nodes or the spleen where they stimulate other cells of the immune system to make vigorous responses, in particular, the B cells that make antibodies to neutralize the invaders and killer T cells that launch specific attacks to destroy them.

Semi-mature dendritic cells are tolerogenic. New research is showing that dendritic cells are equally responsible for a seemingly opposite role in health called immune tolerance, which silences dangerous immune cells and prevents them from attacking innocuous materials in the body or the body's own tissues.

Dendritic cells not only instigate unwanted innate and adaptive responses that cause disease, but also can suppress these conditions. This is why they are the subjects of many lupus scientific inquiries. Dendritic cells are key in studying the disease and in designing treatments.

Tolerogenic

Tolerance

Tolerance is the prevention of an immune response against a particular antigen. For instance, the immune system is generally tolerant of self-antigens, so it does not usually attack the body's own cells, tissues, and organs. However, when tolerance is lost, disorders like autoimmune disease or food allergy may occur.

Titer

Antibody titer is a laboratory test that measures the level of antibodies in a blood sample.

The antibody level in the blood tells your doctor whether or not you have been exposed to an antigen or something that the body thinks is foreign. The body uses antibodies to attack and remove foreign substances.

Thymus

The thymus is a soft organ with two lobes that is located anterior to the ascending aorta and posterior to the sternum. It is relatively large in infants and children but after puberty it begins to decrease in size so that in older adults it is quite small.

The primary function of the thymus is the processing and maturation of special lymphocytes called T-lymphocytes or T-cells. While in the thymus, the lymphocytes do not respond to pathogens and foreign agents. After the lymphocytes have matured, they enter the blood and go to other lymphatic organs where they help provide defense against disease. The thymus also produces a hormone, thymosin, which stimulates the maturation of lymphocytes in other lymphatic organs.

Thrombocytopenia

Thrombocytopenia is a condition in which your blood has a lower than normal number of blood cell fragments called platelets. When your blood has too few platelets, mild to serious bleeding can occur. Bleeding can occur inside your body (internal bleeding) or underneath your skin or from the surface of your skin (external bleeding).

Terminated

Temporal arteritis

Temporal arteritis is inflammation and damage to the blood vessels that supply blood to the head.

Temporal arteritis commonly occurs in the the arteries around the temples (temporal arteries). These vessels branch off from the carotid artery in the neck. However, the condition can occur in medium-to-large arteries in other places in the body.

The cause of the condition is unknown. It is believed to be due in part to a faulty immune response. The disorder has been linked to severe infections and the use of high doses of antibiotics.

T Follicular Helper cells (TFH)

T follicular helper cells (TFH) are a type of helper T cells that direct the development of antibodies. TFH cells normally function to direct B cells to make antibodies against pathogens.

However, an increase in their number or function is associated with lupus, and their accelerated development or persistence is believed to drive the production of those dangerous autoantibodies. The ALR is currently funding a study to better understand the function of TFH.

T cells

T cells are a type of blood cell that belong to a group of white blood cells (WBCs) called lymphocytes, which help the body fight infection. T cells play a major role in protecting the immune system by identifying, directly attacking, and destroying infectious agents.

Like B cells, T cells are produced in bone marrow. But unlike B cells, they mature and develop in the thymus, an organ in the chest — hence the name, T cells. When fully matured, T cells are present in the blood and lymph nodes.

The function of B cells and T cells is vital to the immune system, allowing humans to ward off and better cope with often-hostile bacteria, viruses, and other foreign matter.

Systemic Lupus Erythematosus (SLE)

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

The underlying cause of autoimmune diseases is not fully known.

SLE is much more common in women than men. It may occur at any age, but appears most often in people between the ages of 10 and 50. African Americans and Asians are affected more often than people from other races.

Systemic

Synovitis

Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints which possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection.

Synovitis may occur in association with arthritis as well as lupus, gout, and other conditions. Synovitis is more commonly found in rheumatoid arthritis than in other forms of arthritis, and can thus serve as a distinguishing factor, although it can be present to a lesser degree in osteoarthritis. Long term occurrence of synovitis can result in degeneration of the joint.

Study completion date

The date that the final data for a clinical study were collected because the last study participant has made the final visit to the study location (that is, "last subject, last visit"). The "estimated study completion date" is the date that researchers think will be the completion date for the study.

Stratification

Steroids

Steroids is the shortened term for corticosteroids, a drug commonly used to reduce inflammation in lupus. The term steroids is not to be confused with the male hormone-related steroid compounds designed to enhance athletic performance.

SLP-76

SLP76 an adaptor protein involved in signaling through the T cell antigen receptor complex and signaling in other hematopoietic lineages including platelets. Platelets deficient in SLP76 do not couple GPVI engagement with the signaling cascade that induces degranulation and aggregation in response to collagen.

SLEDAI

Sjogren's syndrome

Sjogren's syndrome is a disease that causes dryness in your mouth and eyes. It can also lead to dryness in other places that need moisture, such as your nose, throat and skin. Most people who get Sjogren's syndrome are older than 40. Nine of 10 are women. Sjogren's syndrome is sometimes linked to rheumatic problems such as rheumatoid arthritis.

In Sjogren's syndrome, your immune system attacks the glands that make tears and saliva. It may also affect your joints, lungs, kidneys, blood vessels, digestive organs and nerves. The main symptoms are:

Signal Transduction

A basic process in molecular cell biology involving the conversion of a signal from outside the cell to a functional change within the cell. A signal (such as a hormone or neurotransmitter) interacts with a receptor on the cell surface; this interaction causes a change in a second messenger (such calcium); and, eventually, a change is triggered in the cell's function (for example, the cell divides).

Serositis

Serositis refers to inflammation of the serous tissues of the body, the tissues lining the lungs (pleura), heart (pericardium), and the inner lining of the abdomen (peritoneum) and organs within. It is commonly found with fat wrapping or creeping fat.

Serious adverse event

An adverse event that results in death, is life-threatening, requires inpatient hospitalization or extends a current hospital stay, results in an ongoing or significant incapacity or interferes substantially with normal life functions, or causes a congenital anomaly or birth defect. Medical events that do not result in death, are not life-threatening, or do not require hospitalization may be considered serious adverse events if they put the participant in danger or require medical or surgical intervention to prevent one of the results listed above.

Seizure

Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. When people think of seizures, they often think of convulsions in which a person's body shakes rapidly and uncontrollably. Not all seizures cause convulsions. There are many types of seizures and some have mild symptoms. Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity on both sides of the brain.

In some cases, lupus affecting the central nervous system can cause seizures.

Sources: MedlinePlus; National Institute of Arthritis and Musculoskeletal and Skin Diseases

Sedimentation rate

Secondary outcome measure

A planned outcome measure in the protocol that is not as important as the primary outcome measure, but is still of interest in evaluating the effect of an intervention. Most clinical studies have more than one secondary outcome measure.

Scleroderma

Scleroderma is a connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs. It is a type of autoimmune disorder, a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue.

The cause of scleroderma is unknown. People with this condition have a buildup of a substance called collagen in the skin and other organs. This buildup leads to the symptoms of the disease.

The disease usually affects people 30 to 50 years old. Women get scleroderma more often than men do. Some people with scleroderma have a history of being around silica dust and polyvinyl chloride, but most do not.

Widespread scleroderma can occur with other autoimmune diseases, including systemic lupus erythematosus and polymyositis. In such cases, the disorder is referred to as mixed connective disease.

Scientific Advisory Board (SAB)

Rheumatologist

A rheumatologist is a doctor who diagnoses, treats and medically manages patients with arthritis and other rheumatic diseases. These health problems affect the joints, muscles, bones and sometimes other internal organs (e.g., kidneys, lungs, blood vessels, brain).

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in your joints. It can affect any joint but is common in the wrist and fingers. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime.

Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth and lungs.

No one knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute. Treatments include medicine, lifestyle changes and surgery.

Rheumatism

Rheumatism or rheumatic disorder is a non-specific term for medical problems affecting the joints and connective tissue. The study of, and therapeutic interventions in, such disorders is called rheumatology.

Remission

Raynaud's phenomenon

Raynaud's Phenomenon is a rare disorder that affects the arteries. Arteries are blood vessels that carry blood from your heart to different parts of your body.

Raynaud's sometimes is called a disease, syndrome, or phenomenon. The disorder is marked by brief episodes of vasospasm (VA-so-spazm), which is a narrowing of the blood vessels.

Vasospasm of the arteries reduces blood flow to the fingers and toes. In people who have Raynaud's, the disorder usually affects the fingers. In about 40 percent of people who have Raynaud's, it affects the toes. Rarely, the disorder affects the nose, ears, nipples, and lips.

Pulse steroids

Pulmonary hypertension

Pulmonary hypertension occurs when the blood pressure in the pulmonary arteries, which carry oxygen and blood from the heart to the lungs, is much higher than normal.

Pulmonary hypertension usually occurs along with another disease or condition, such as pregnancy, heart and blood vessel diseases, lung diseases, liver diseases, sleep apnea, connective tissue diseases such as lupus and scleroderma, thyroid diseases, HIV infection, or use of certain diet medicines or illicit drugs.

In 2002, pulmonary hypertension led to 15,668 deaths and 260,000 hospital visits in the United States.

Pulmonary hypertension can affect men and women of all ages and racial/ethnic groups. However, the majority of people who have this condition are older women.

Pulmonary function tests

Pulmonary function tests are a group of non-invasive tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation.

Publications

Published scientific articles or abstracts about a clinical study. A publication reference, also called a citation, may be submitted to ClinicalTrials.gov at any time. It can also be automatically identified by the NCT Number, which is indexed in MEDLINE®, a database of biomedical and life sciences journal citations.

Psychosis

Psychosis is a loss of contact with reality, possibly including hallucinations or delusions. While neuropsychiatric manifestations are fairly common in systemic lupus erythematosus, psychosis is uncommon.

Proteoglycan

Proteoglycans are glycosylated proteins which have covalently attached highly anionic glycosaminoglycans. Many forms of proteoglycans are present in virtually all extracellular matrices of connective tissues. The major biological function of proteoglycans derives from the physicochemical characteristics of the glycosaminoglycan component of the molecule, which provides hydration and swelling pressure to the tissue enabling it to withstand compressional forces. This function is best illustrated by the most abundant proteoglycan in cartilage tissues, aggrecan.

Proteinuria

Proteinuria (also called albuminuria or urine albumin) is a condition in which urine contains an abnormal amount of protein. Albumin is the main protein in the blood. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions. They protect the body from infection, help blood clot, and keep the right amount of fluid circulating throughout the body.

Proteinuria is a sign of chronic kidney disease (CKD). If CKD progresses, it can lead to end-stage renal disease (ESRD), when the kidneys fail completely. A person with ESRD must receive a kidney transplant or regular blood-cleansing treatments called dialysis.

Proliferative lupus nephritis

The term for severe stages of lupus nephritis — or inflammation of the kidneys due to lupus – is proliferative lupus nephritis. Lupus nephritis is a serious condition, which occurs when autoantibodies affect the filtering structure of the kidneys. Proliferative lupus nephritis may lead to blood or protein in the urine, impaired kidney function, or even kidney failure.

At any stage of lupus nephritis, early diagnosis and treatment can greatly improve outcomes.

Primary outcome measure

The planned outcome measure in the protocol that is the most important for evaluating the effect of an intervention. Most clinical studies have one primary outcome measure, but some may have more than one.

Prednisone

Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include lupus, certain types of arthritis; severe allergic reactions; multiple sclerosis (a disease in which the nerves do not function properly); and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer.

Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.

Polymyositis

Polymyositis is a rare inflammatory disease that leads to muscle weakness, swelling tenderness, and tissue damage. It is part of a larger group of diseases called myositis.

Polymyositis affects the skeletal muscles. It is also known as idiopathic inflammatory myopathy. The exact cause is unknown, but it may be related to an autoimmune reaction or infection.

Polymyositis can affect people at any age. It most common in adults between ages 50 and 70, and in children ages 5 to 15. It affects women twice as often as men. It is more common in African Americans than Caucasians.

Polymyalgia rheumatica

Polymyalgia rheumatica is a disorder that causes muscle pain and stiffness in your neck, shoulders, and hips. It is most common in women and almost always occurs in people over 50. The main symptom is stiffness after resting. Other symptoms include fever, weakness and weight loss. In some cases, polymyalgia rheumatica develops overnight. In others, it is gradual.

Polyarteritis nodosa

Polyarteritis nodosa is a disease similar to lupus. In polyarteritis nodosa, the small and medium-sized arteries become swollen and damaged. Symptoms are caused by damage to affected organs. The skin, joints, muscle, gastrointestinal tract, heart, kidneys, and nervous system are often affected.

Pleural effusion

A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity.

Your body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, the thin tissue that lines the chest cavity and surrounds the lungs. A pleural effusion is an abnormal, excessive collection of this fluid.

There are two different types:

Transudative pleural effusions are caused by fluid leaking into the pleural space. This is caused by increased pressure in the blood vessels or a low blood protein count. Congestive heart failure is the most common cause.

Pleura

The pleura is a large, thin sheet of tissue that wraps around the outside of the lungs and lines the inside of the chest cavity. Between the layers of the pleura is a very thin space. Normally it's filled with a small amount of fluid. The fluid helps the two layers of the pleura glide smoothly past each other as the lungs breathe air in and out.

Platelet

Plasmapheresis

Plasmapheresis is a process in which the fluid part of the blood, called plasma, is removed from blood cells by a device known as a cell separator. The separator works either by passing the blood at high speed to separate the cells from the fluid or by passing the blood through a membrane with pores so small that only the fluid part of the blood can pass through. The cells are returned to the person undergoing treatment, while the plasma, which contains the antibodies, is discarded and replaced with other fluids. Medication to keep the blood from clotting (an anticoagulant) is given through a vein during the procedure.

Plaquenil (hydroxychloroquine)

Hydroxychloroquine is in a class of drugs called antimalarials. It is used to prevent and treat acute attacks of malaria. It is also used to treat discoid or systemic lupus erythematosus and rheumatoid arthritis in patients whose symptoms have not improved with other treatments.

Photosensitivity

Phospholipases

Phopholipases are a group of enzymes that catalyze the cleavage of phospholipids. While some phospholipases possess substrate specificity for certain phospholipid species, some can catalyze the cleavage of other lipophillic molecules (such as triacylglycerols) in addition to phospholipids.

Phlebitis

Phlebitis is an inflammation of a vein, usually in the legs.

When phlebitis is associated with the formation of blood clots (thrombosis), usually in the deep veins of the legs, the condition is called thrombophlebitis. These clots can travel to the lungs, causing pulmonary embolisms that can be fatal.

Phenotype

Phagocyte

A cell that can engulf particles, such as bacteria and other microorganisms or foreign matter. The principal phagocytes include the neutrophils and monocytes, both of which are types of white blood cells.

PGA

PGA, short for “Physician’s Global Assessment,” is a term that refers to the scale of a patient’s well being based on the impression of the clinician. Ratings are made on a scale from 0 to 3, measuring the severity of disease (0 = inactive, 1 = mild, 2 = moderate, 3 = severe).

Pernicious anemia

Peritonitis

Peritonitis is inflammation of the peritoneum — a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen — that is usually due to a bacterial or fungal infection. Peritonitis can result from any rupture (perforation) in your abdomen, or as a complication of other medical conditions.

Pericarditis

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed. The cause of pericarditis is often unknown or unproven, but is often the result of an infection such as:

Viral infections that cause a chest cold or pneumonia, such as the echovirus or coxsackie virus (which are common in children), as well as influenza

Infections with bacteria (much less common) and some fungal infections (even more rare)

Other causes include:

Heart attack

Heart surgery or trauma to the chest, esophagus, or heart

Certain medications and some drugs used to treat cancer or suppress the immune system

Pathology

Parallel Design

Describes a clinical trial in which two or more groups of participants receive different interventions. For example, a two-arm parallel design involves two groups of participants. One group receives drug A, and the other group receives drug B. So during the trial, participants in one group receive drug A "in parallel" to participants in the other group receiving drug B.

Panniculitis

Panniculitis is an inflammation of the panniculus, the layer of fatty and fibrous tissue just beneath the outer layers of our skin. This layer of the skin looks like a honeycomb, with globules of fat separated by walls, or septae.

Like most medical conditions, panniculitis can have many underlying causes, including diseases that involve widespread inflammation of the body such as lupus (systemic lupus erythematosus) and rheumatoid arthritis, and reactions to some drugs, including corticosteroids.

Overlap syndrome

The term overlap syndrome includes a large group of conditions characterized by the coexistence of signs, symptoms and immunological features of 2 or more connective tissue diseases and occurring simultaneously in the same patient.

Source: Clinics and Practice: An International Journal of Medical Case Reports

Outcomes Research

Outcomes research seeks to understand the end results of particular health care practices and interventions. End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditions—where cure is not always possible—end results include quality of life as well as mortality.

Source: US Dept. of Health & Human Services, Agency for Heathcare Research and Quality

Outcome measure

A planned measurement described in the protocol that is used to determine the effect of interventions on participants in a clinical trial. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment.

Osteoporosis

A skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Bone strength reflects the integration of two main features: bone density and bone quality. Bone density is expressed as grams of mineral per area or volume and in any given individual is determined by peak bone mass and amount of bone loss. Bone quality refers to architecture, turnover, damage accumulation (e.g., microfractures) and mineralization. A fracture occurs when a failure-inducing force (e.g., trauma) is applied to osteoporotic bone. Thus, osteoporosis is a significant risk factor for fracture, and a distinction between risk factors that affect bone metabolism and risk factors for fracture must be made.

Osteoblast

A cell that makes bone. It does so by producing a matrix that then becomes mineralized. Bone mass is maintained by a balance between the activity of osteoblasts that form bone and other cells called osteoclasts that break it down.

Osteoarthrits

Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

Observational Study

A clinical study in which participants identified as belonging to study groups are assessed for biomedical or health outcomes. Participants may receive diagnostic, therapeutic, or other types of interventions, but the investigator does not assign participants to specific interventions (as in an interventional study).

Nucleic Acid Binding Polymers (NABPs)

Nucleic acids are molecules that are essential to the structure of DNA, RNA, and all forms of life. A polymer is a large molecule composed of many smaller molecules lined together.

NABPs inhibit toll-like receptor (TLRs) activation and subsequent cytokine production of dendritic cells and B cells. In lupus, TLRs play a critical role in innate and adaptive immune responses by responding to pathogenic nucleic acids.

With funding from the Alliance for Lupus Research, David Pisetsky, MD, PhD, from Duke University Medical Center, NC is looking at ways that NABPs can be used in lupus treatment. “These polymers can bind tightly to DNA and RNA and prevent the formation of immune complexes and the resulting stimulation of internal receptors. The hope is that the polymers will be able to block the ability of extracellular nucleic acids to stimulate immune system activity that can underlie autoimmunity,” said Dr. Pisetsky.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

The muscle and joint pain associated with lupus—as well as other chronic conditions where inflammation is present—are most often treated with non-steroidal anti-inflammatory drugs (NSAIDs). Examples of over-the-counter NSAIDs are aspirin and ibuprofen.

NSAIDs work by preventing an enzyme called cyclooxygenase from functioning. This enzyme protects the stomach lining, which is why NSAIDs can cause stomach upset and bleeding.

Neutrophils

The most abundant type of white blood cells in humans, neutrophils are important for the defense against infection. Neutrophils are fast acting, arriving at the site of infection within an hour. They can ingest and kill bacteria and are the main component of pus.

More than 50 percent of all white blood cells occurring in the human body are neutrophils.

With ALR funding Michael Denny, PhD, at Temple University in Philadelphia, PA, worked to broaden the understanding of the relationship between neutrophils and lupus. Dr. Denny and his team identified an abnormal pool of neutrophils in people with the disease. “These cells may contribute to disease manifestation like skin rashes,” explained Dr. Denny.

Neutrophil extracellular traps (NETs)

Neutrophil extracellular traps (NETs) are chromatin structures loaded with antimicrobial molecules. They can trap and kill various bacterial, fungal and protozoal pathogens, and their release is one of the first lines of defense against pathogens.

Neuropathy

Peripheral neuropathy describes damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (the central nervous system) to every other part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that the feet are cold or a finger is burned. Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral neuropathy distorts and sometimes interrupts messages between the brain and the rest of the body.

Neurologist

Neurologic disorders

Neurologic disorders are diseases of the brain, spinal cord and nerves throughout your body. Together they control all the workings of the body. When something goes wrong with a part of your nervous system, you can have trouble moving, speaking, swallowing, breathing or learning. You can also have problems with your memory, senses or mood.

There are more than 600 neurologic diseases. Major types include

Diseases caused by faulty genes, such as Huntington's disease and muscular dystrophy

Problems with the way the nervous system develops, such as spina bifida

Degenerative diseases, where nerve cells are damaged or die, such as Parkinson's disease and Alzheimer's disease

Nephrologist

Nephritis

Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE or lupus). SLE is an autoimmune disease—a disorder in which the body’s immune system attacks the body’s own cells and organs. Up to 60 percent of people with SLE are diagnosed with lupus nephritis, which can lead to significant illness and even death.

Neonatal lupus

Neonatal lupus is a rare condition – about 1 to 2 percent of babies born to mothers who have autoimmune disease or carry the antibodies to SSA/Ro and/or SSB/La [1,2] will develop neonatal lupus. The disease is presumed to be the result of these antibodies crossing the placenta in pregnancy from mother to her developing baby.

Neonatal lupus is usually benign and the signs — such as skin rash, liver problems, and low blood cell counts —are generally short lived. Symptoms usually disappear within months after birth, when infants begin to develop their own immune system — and, the mother’s antibodies leave the baby’s body.

Myositis

Myositis is inflammation of your skeletal muscles, which are also called the voluntary muscles. These are the muscles you consciously control that help you move your body. An injury, infection or autoimmune disease can cause myositis.

The diseases dermatomyositis and polymyositis both involve myositis. Polymyositis causes muscle weakness, usually in the muscles closest to the trunk of your body. Dermatomyositis causes muscle weakness, plus a skin rash. Both diseases are usually treated with prednisone, a steroid medicine, and sometimes other medicines

Myocarditis

Myocarditis is inflammation of the heart muscle.

Myocarditis is an uncommon disorder. Most of the time, it is caused by a viral, bacterial, or fungal infection that reaches the heart.

When you have an infection, your immune system produces special cells to fight off disease. If the infection affects your heart, the disease-fighting cells enter the heart. However, the chemicals produced by an immune response can damage the heart muscle. As a result, the heart can become thick, swollen, and weak. This leads to symptoms of heart failure.

Myocardial infarction

A myocardial infarction, or heart attack, occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood flow can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis . When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). About every 34 seconds, someone in the United States has a myocardial infarction.

Myeloid Cells

Granulocytes and monocytes, collectively called myeloid cells, are differentiated descendants from common progenitors derived from hematopoietic stem cells in the bone marrow. Commitment to either lineage of myeloid cells is controlled by distinct transcription factors followed by terminal differentiation in response to specific colony-stimulating factors and release into the circulation. Upon pathogen invasion, myeloid cells are rapidly recruited into local tissues via various chemokine receptors, where they are activated for phagocytosis as well as secretion of inflammatory cytokines, thereby playing major roles in innate immunity.

Myalgia

Myalgia is a term for muscle aches and pains. Muscle pain also can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs.

Myalgia is most frequently related to tension, overuse, or muscle injury from exercise or physically-demanding work. In these situations, the pain tends to involve specific muscles and starts during or just after the activity. It is usually obvious which activity is causing the pain.

Muscle pain also can be a sign of conditions affecting your whole body, like some infections (including the flu) and disorders that affect connective tissues throughout the body (such as lupus).

Musculoskeletal

The musculoskeletal system is comprised of the bones, muscles, and joints.

Involvement of the musculoskeletal system is extremely common in patients with lupus, manifesting primarily in arthralgia, arthritis, myopathy (muscle disorders), and osteonecrosis (loss of blood to bone, causing bone deterioration).

Monocyte

Monocytes, a type of white blood cells, help protect the body against bacteria. After circulating in the bloodstream for about a day, monocytes enter body tissues to become macrophages, which can destroy some germs by surrounding and digesting them.

Monoclonal antibodies

Naturally occurring in the human body, antibodies are a “sticky” protein that targets a specific antigen. These antibodies circulate in the body, find and attach to the antigen, and recruit other parts of the immune system to destroy the cells containing the antigen.

A monoclonal antibody is a man-made, laboratory-produced protein that is designed to target a certain antigen. The advantage of infection-fighting proteins is that they are highly specific, identical, and can be produced in large quantities.

Monoclonal antibodies are now used as therapies for a number of diseases.

Mixed connective tissue disease

Mixed connective tissue disease (MCTD) is a autoimmune disorder that causes overlapping features of three connective tissue disorders: lupus, scleroderma, and polymyositis. MCTD may also have features of rheumatoid arthritis. This condition is most often diagnosed in women in their 20's and 30's. Occasionally, children are affected.At this time the cause of this condition is unknown.

Mitogen-activated Protein Kinase (MAPK)

Signal transduction networks allow cells to perceive changes in the extracellular environment and to mount an appropriate response. Mitogen-activated protein kinase (MAPK) cascades are among the most thoroughly studied of signal transduction systems and have been shown to participate in a diverse array of cellular programs, including cell differentiation, cell movement, cell division, and cell death.

MicroRNAs

Found in plants and mammals, microRNAs (miRNA) are small RNA molecules, which increase or decrease the production of specific gene protein or RNA. Aberrant expression of miRNA has been seen in numerous disease states.

Microbial metabolites

Metabolism refers to the physical and chemical processes that occur within all living cells or organisms. Such processes are essential for the maintenance of life. Metabolites are the intermediate products of metabolic reactions catalyzed by various enzymes that naturally occur within the cells. This term is usually used to describe small molecules.

Microbial metabolism is the means by which a microbe obtains the energy and nutrients (e.g. carbon) it needs to live and reproduce. Microbes use many different types of metabolic strategies and species can often be differentiated from each other based on metabolic characteristics.

In scientific research, microbial metabolites represent an amazingly diverse array of chemistry— an unmatched resource for the discovery of novel microbial compounds that may be useful in human application.

Metalloproteinase

A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis.

Metabolism

The whole range of biochemical processes that occur within a living organism. Metabolism consists of anabolism (the buildup of substances) and catabolism (the breakdown of substances). The term metabolism is commonly used to refer specifically to the breakdown of food and its transformation into energy.

Medical Informatics

Health or Medical Informatics is the "scientific field that deals with biomedical information, data, and knowledge - their storage, retrieval, and optimal use for problem solving and decision making. It accordingly touches on all basic and applied fields in biomedical science and is closely tied to modern information technologies, notably in the areas of computing and communication (medical computer science)"

Malar rash

The malar rash, or butterfly rash, is a red flat facial rash involving the malar region bilaterally and the bridge of the nose. The presence of a butterfly rash is generally a sign of lupus erythematosus (LE), but it can also include a plethora of conditions.

Major Histocompatibility Complex (MHC)

Cells continually break apart a few of their old, obsolete proteins and display the pieces on their surfaces. The small peptides are held in MHC, the major histocompatibility complex, which grips the peptides and allow the immune system to examine them. In this way, the immune system can monitor what is going on inside the cell. If all the peptides displayed on the cell surface are normal, the immune system leaves the cell alone. But if there is a virus multiplying inside the cell, many of the MHC molecules carry unusual peptides from viral proteins, and the immune system kills the cell.

Macrophages

The role of microphages is not completely known, but scientific research has shown that these cells attack foreign substances and infectious microbes through destruction and ingestion. Derived from Greek, macrophages translates as “big eaters.”

Recent research suggests that macrophages in people with lupus may have intrinsic defects that hamper its normal function.

Lymphocytes

Lymph nodes

Lymph nodes are small organs of the immune system spread throughout the body. They behave as filters or traps for foreign particles. Lymph nodes contain cells that become lymphocytes and are important in the proper functioning of the immune system.

Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases as well.

Lupus Mouse Model

Mouse models have significantly contributed to our understanding of the pathogenesis of SLE (Systemic lupus erythematosus). Unlike most other mouse models of autoimmunity and inflammation, SLE in mice closely resembles human SLE, including autoantibody production and renal disease. Congenic strains have allowed researchers to study the complicated genetics of SLE, both polygenic and at the single-gene level. There are many mouse models of SLE, and choosing the most appropriate for a question of interest requires an understanding of the clinical, pathological, and genetic features of each model. There are two main categories of mouse models of SLE: spontaneous (and their congenic counterparts) and induced (which includes gene targeting).

Lupus

Lupus is one of many disorders of the immune system known as autoimmune diseases. In autoimmune diseases, the immune system turns against parts of the body it is designed to protect. This leads to inflammation and damage to various body tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Although people with the disease may have many different symptoms, some of the most common ones include extreme fatigue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and kidney problems.

Livedo reticularis

Livedo reticularis refers to a netlike pattern of reddish-blue skin discoloration. Usually the legs are affected. The condition is linked to swollen blood vessels. It may get worse when the temperature is cold.

The cause of livedo reticularis is not known, therefore specific treatment is usually not recommended. If the condition is due to exposure to cold, keeping the legs warm may help relieve the symptoms.

Lipid

Another word for "fat." A lipid is chemically defined as a substance that is insoluble in water and soluble in alcohol, ether, and chloroform. Lipids are an important component of living cells. Together with carbohydrates and proteins, lipids are the main constituents of plant and animal cells. Cholesterol and triglycerides are lipids. Lipids are easily stored in the body. They serve as a source of fuel and are an important constituent of the structure of cells. Lipids include fatty acids, neutral fats, waxes and steroids (like cortisone). Compound lipids (lipids complexed with another type of chemical compound) comprise the lipoproteins, glycolipids and phospholipids.

Leukopenia

Leukopenia is an abnormal reduction of circulating white blood cells, especially the granulocytes. The term leukopenia is often used interchangeably with neutropenia. It may result from reduced production of white blood cells or increased utilization and destruction, or both. Infection, drugs, malignancy, megaloblastosis, hypersplenism and immunoneutropenia are responsible for most cases of neutropenia. Primary neutropenia is very rare. Sometimes, particularly in children, primary neutropenia is hereditary and may be associated with other developmental defects. The major danger of neutropenia is the risk of infection. Management requires identification of the cause and effective antimicrobial therapy, especially when serious systemic infection is present.

Kinase inhibitor

A protein kinase inhibitor is a type of enzyme inhibitor that blocks the action of one or more protein kinases. Protein kinases are enzymes that add a phosphate (PO4) group to a protein or other organic molecule. Phosphate groups can turn a protein off.

Kidney

Your kidneys are two bean-shaped organs, each about the size of your fists. They are located near the middle of your back, just below the rib cage. Inside each kidney about a million tiny structures called nephrons filter blood. They remove waste products and extra water, which become urine. The urine flows through tubes called ureters to your bladder, which stores the urine until you go to the bathroom.

Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes. Causes can include genetic problems, injuries, or medicines.

Lupus Nephritis is the form of SLE that causes the kidneys to become inflamed.

Source: NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Juvenile Idiopathic Arthritis (JIA)

The most prevalent form of juvenile arthritis is juvenile idiopathic arthritis (JIA) (also known as juvenile rheumatoid arthritis, or JRA). Arthritis is an inflammation of the joints that is characterized by swelling, heat, and pain. Nearly 300,000 children in the United States have some sort of arthritis. Arthritis can be short-term — lasting for just a few weeks or months, then going away forever — or it can be chronic and last for months or years. In rare cases, it can last a lifetime. JIA usually appears in kids between 6 months and 16 years old. The first signs often are joint pain or swelling and reddened or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.

Janus Kinase Inhibitors (JAK)

Janus kinase inhibitors also known as JAK inhibitors are a type of medication that functions by inhibiting the activity of one or more of the Janus kinase family of enzymes (JAK1, JAK2, JAK3, TYK2), thereby interfering with the JAK-STAT signaling pathway. These inhibitors have therapeutic application in the treatment of cancer and inflammatory diseases.

Intravenous pyelogram (IVP)

An intravenous pyelogram (IVP) is a special x-ray examination of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder).

An intravenous pyelogram is performed by injecting contrast material into a vein in the arm. A series of x-rays are taken at timed intervals as the contrast material goes through the kidneys, the ureters, and the bladder. The procedure helps to evaluate the condition of those organs.

Intravenous (IV) infusion

Intravenous infusion or IV infusion is a medical term that describes the way certain kinds of medicines or other substances, such as nutrition, are delivered to the body. This method is often used when the substance cannot be taken orally. Sometimes the therapy must bypass the gut or go directly into the veins.

Many therapies are delivered via IV infusion—including intravenous steroids and chemotherapeutic agents for people with lupus.

Intervention

A process or action that is the focus of a clinical study. This can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches such as surveys, education, and interviews.

Interstitial Pneumonitis

Interstitial lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. The scarring associated with interstitial lung disease eventually affects your ability to breathe and get enough oxygen into your bloodstream.

Pneumonitis is a general term that refers to inflammation of lung tissue. Although pneumonia is technically a type of pneumonitis because the infection causes inflammation, most doctors are referring to other causes of lung inflammation when they use the term "pneumonitis."

Factors that can cause pneumonitis include exposure to airborne irritants at your job or from your hobbies. In addition, some types of cancer treatments and dozens of drugs can cause pneumonitis.

The most common symptom of pneumonitis is shortness of breath, which may be accompanied by a dry cough. If pneumonitis is undetected or left untreated, you may gradually develop chronic pneumonitis, which can result in scarring (fibrosis) in the lungs.

Interferon Regulatory Factor 5 (IRF 5)

IRF5 is one of the interferon regulatory factors, a group of transcription factors with diverse roles within the body. Among its many functions, IRF-5 influences virus-mediated activation of interferon, the modulation of cell growth, differentiation, apoptosis, and immune system activity.

It acts as a molecular switch that controls whether macrophages will promote or inhibit inflammation. The ALR has funded investigations to better grasp an understanding of RF5 in regard to lupus manifestation.

Interferon

Interferons (IFNs) are proteins made and released by host cells in response to the presence of pathogens such as viruses, bacteria, parasites or tumor cells. They allow for communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.

Integrin

the principal receptors on animal cells for binding most extracellular matrix proteins—including collagens, fibronectin, and laminins—are the integrins.

Integrins, like other cell adhesion molecules, differ from cell-surface receptors for hormones and for other extracellular soluble signal molecules in that they usually bind their ligand with lower affinity and are usually present at about tenfold to a hundredfold higher concentration on the cell surface. If the binding were too tight, cells would presumably become irreversibly glued to the matrix and would be unable to move—a problem that does not arise if attachment depends on large numbers of weak adhesions. This is an example of the “Velcro principle” mentioned earlier. Like other transmembrane cell adhesion proteins, however, integrins do more than just attach a cell to its surroundings. They also activate intracellular signaling pathways that communicate to the cell the character of the extracellular matrix that is bound.

Innate Immunity

During the first critical hours and days of exposure to a new pathogen, we rely on our innate immune system to protect us from infection.

Innate immune responses are not specific to a particular pathogen in the way that the adaptive immune responses are. They depend on a group of proteins and phagocytic cells that recognize conserved features of pathogens and become quickly activated to help destroy invaders.

Informed Consent

The goal of the informed consent process is to protect participants. It begins when a potential participant first asks for information about a study and continues throughout the study until the study ends. The researcher and potential participant have discussions that include answering the participant's questions about the research. All the important information about the study must also be given to the potential participant in a written document that is clear and easy to understand. This informed consent document is reviewed and approved by the human subjects review board for a study before it is given to potential participants. Generally, a person must sign an informed consent document to enroll in a study.

Inflammation

An inflammatory response (inflammation) occurs when tissues are injured by bacteria, trauma, toxins, heat, or any other cause. The damaged cells release chemicals including histamine, bradykinin, and prostaglandins. These chemicals cause blood vessels to leak fluid into the tissues, causing swelling. This helps isolate the foreign substance from further contact with body tissues.

Inclusion Criteria

Immunosuppressive

Immunosuppressive is a term that refers to the lowering of the body’s normal immune response. It can occur naturally through the aging process, as the side effect of medical therapy, or it can be deliberately induced to treat diseases like lupus.

In lupus, immunosuppressive drugs are sometimes used to address the hyperactivity of the immune system, which triggers the inflammatory response and can cause severe pain in the joints, skin, and kidneys of patients with the disease.

Immunosuppressive drugs are also used to prevent the body from rejecting a transplanted organ. Along the same lines, this therapy is used in lupus to prevent the from body attacking or rejecting healthy tissue.

Immunoglobulin

Immunoglobulins, or antibodies, are the cells and molecules of the immune system that detect and attack invaders. In diseases like lupus, antibodies mistakenly attack a patient’s own tissue and organs.

Immunogenicity

Immunogenicity is the ability of a particular substance, such as an antigen or epitope, to provoke an immune response in the body of a human or animal. In other words, immunogenicity is the ability to induce a humoral and/or cell mediated immune response.

Immunogenic dendritic cells

Discovered just 35 years ago, dendritic cells are profoundly changing the science of immunology. While the precise role of dendritic cells in lupus is not yet known, we do know they are antigen-presenting cells that both control and curtail immunity. Dendritic cells are divided into two main subsets.

Mature dendritic cells are immunogenic. They patrol the body seeking out foreign invaders, whether these are bacteria, viruses, or dangerous toxins. After capturing the invaders, often termed antigens, dendritic cells convert them into smaller pieces and display the antigenic fragments on their cell surfaces. The dendritic cells then travel to lymph nodes or the spleen where they stimulate other cells of the immune system to make vigorous responses, in particular, the B cells that make antibodies to neutralize the invaders and killer T cells that launch specific attacks to destroy them.

Semi-mature dendritic cells are tolerogenic. New research is showing that dendritic cells are equally responsible for a seemingly opposite role in health called immune tolerance, which silences dangerous immune cells and prevents them from attacking innocuous materials in the body or the body's own tissues.

Dendritic cells not only instigate unwanted innate and adaptive responses that cause disease, but also can suppress these conditions. This is why they are the subjects of many lupus scientific inquiries. Dendritic cells are key in studying the disease and in designing treatments.

Immune system

The human immune system is a complicated organization of cells and pathways within the body that seeks and responds to foreign invaders such as bacteria, viruses, and other infectious agents — as well as foreign material such as pollen. Composed of numerous and varied cells—each with a specific task — the immune system is the body’s defense mechanism.

Immune Response

The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful.The immune system protects the body from possibly harmful substances by recognizing and responding to antigens. Antigens are substances (usually proteins) on the surface of cells, viruses, fungi, or bacteria. Nonliving substances such as toxins, chemicals, drugs, and foreign particles (such as a splinter) can also be antigens. The immune system recognizes and destroys substances that contain antigens. Your own body's cells have proteins that are antigens. These include a group of antigens called HLA antigens. Your immune system learns to see these antigens as normal and usually does not react against them.

Immune complex

Immune complex occurs when an antibody binds to an antigen, such as toxins, microorganisms, and proteins that are foreign to the body. Immune complex molecules help fight disease—but in lupus, individuals form autoantibodies that attack the person’s own tissue and organs.

Hypertrophy

Human Subjects Review Board

A group of people who review, approve, and monitor the clinical study protocol. Their role is to protect the rights and welfare of human research subjects participating in a study. The group typically includes people with varying backgrounds, including a community member, to make sure that research activities conducted by an organization are completely and adequately reviewed. Also known as an institutional review board (IRB) or ethics committee.

Hemiparesis

Hematuria

Hematuria is blood in the urine. Two types of blood in the urine exist. Blood that can be seen in the urine is called gross hematuria. Blood that cannot be seen in the urine, except when examined with a microscope, is called microscopic hematuria.

Source: National Institute of Diabetes and Digestive and Kidney Diseases

Hematopoiesis

The production of all types of blood cells including formation, development, and differentiation of blood cells. Prenatally, hematopoiesis occurs in the yolk sack, then in the liver, and lastly in the bone marrow. In the normal situation, hematopoiesis in adults occurs in the bone marrow and lymphatic tissues. All types of blood cells are derived from primitive cells (stem cells) that are pluripotent (they have the potential to develop into all types of blood cells).

Hematologist

Hematologic disorders

Hematolic disorders affect one or more parts of the blood and prevent your blood from doing its job. They can be acute or chronic. Many blood disorders are inherited. Other causes include other diseases, side effects of medicines, and a lack of certain nutrients in your diet.

Hematocrit

Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells. This measurement depends on the number of red blood cells and the size of red blood cells.

Heart attack

A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood flow can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis . When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). About every 34 seconds, someone in the United States has a myocardial infarction (heart attack).

Health Authority

Gut Microbiota

Gut Microbiota, which was formerly called gut flora, is the term accepted today for the microbe population living in the intestines of mammals.

In humans, gut microbiota contains tens of trillions of microorganisms, including at least 1000 different species of known bacteria with more than 3 million genes. In a single person, microbiota can weigh up to 4.5 pounds. A third of a person’s gut microbiota is common to most people. The remaining two thirds are specific to that person.

In scientific research, a process known as fecal microbiota transplant (FMT) is being used to transplant microbiota from a healthy individual into a recipient. In the United States, FMT has been experimentally employed to treat gastrointestinal diseases, including colitis, constipation, irritable bowel syndrome and other serious health conditions such as multiple sclerosis, Parkinson’s disease and lupus.

Glycosaminoglycan

Glycosaminoglycans (GAGs) or mucopolysaccharides are long unbranched polysaccharides consisting of a repeating disaccharide unit. The repeating unit (except for keratan) consists of an amino sugar (N-acetylglucosamine or N-acetylgalactosamine) along with a uronic sugar (glucuronic acid or iduronic acid) or galactose. Glycosaminoglycans are highly polar and attract water. They are therefore useful to the body as a lubricant or as a shock absorber.

Genetic Linkage Analysis

Traditionally, the search for a disease gene begins with linkage analysis. In this approach, the aim is to find out the rough location of the gene relative to another DNA sequence called a genetic marker, which has its position already known. The principle of linkage analysis is simple. All our chromosomes come in pairs, one inherited from our mother and one from our father. Each pair of chromosomes contains the same genes in the same order, but the sequences are not identical. This means it should be easy to find out whether a particular sequence comes from our mother or father. These sequence variants are called maternal and paternal alleles.

In the case of the disease gene, the alternative alleles will be the normal allele and the disease allele, and they can be distinguished by looking for occurrences of the disease in a family tree or pedigree. Genetic markers are DNA sequences that show polymorphism (variations in size or sequence) in the population.

Genetic disorder

Genetic disorders are diseases that are caused by abnormal DNA or mutations. These abnomalities can be small changes to a single gene or be much more complex and affect a chromosome or an entire group of chromosomes. Genetic disorders cause a long list of diseases from cystic fibrosis to being more suseptable to various types of cancers.

A study showed 8% of patients with SLE had at least one first-degree family member (parents, siblings and children) with the same diagnosis compared to 0.08% of the general population. This suggests SLE recurs to a modest degree in families.

A twin study showed that SLE recurs in the other sibling in 24% of identical twins and 2% non-identical twins, implying both genetic and environmental factors are important. Researchers have identified multiple gene alterations that contribute to a modestly increased risk for this disease. It is thought that a combination of these genes leads to development of SLE.

Gene Regulation

Gene regulation is the process of turning genes on and off. During early development, cells begin to take on specific functions. Gene regulation ensures that the appropriate genes are expressed at the proper times. Gene regulation can also help an organism respond to its environment. Gene regulation is accomplished by a variety of mechanisms including chemically modifying genes and using regulatory proteins to turn genes on or off.

Gene Expression

Gene expression is the process by which the information encoded in a gene is used to direct the assembly of a protein molecule. The cell reads the sequence of the gene in groups of three bases. Each group of three bases (codon) corresponds to one of 20 different amino acids used to build the protein.

Gene

The gene is the basic physical unit of inheritance. Genes are passed from parents to offspring and contain the information needed to specify traits. Genes are arranged, one after another, on structures called chromosomes. A chromosome contains a single, long DNA molecule, only a portion of which corresponds to a single gene. Humans have approximately 20,000 genes arranged on their chromosomes.

Gastrointestinal

Gastrointestinal refers to the stomach and intestines.

Gastrointestinal (GI) manifestations occur in approximately 25 to 40 percent of patients with systemic lupus erythematosus (SLE). Many of these symptoms are nonspecific, and often reflect either lupus of the GI tract or the effects of medications.

Gastroenterologist

A gastroenterologist is a medical specialist who deals with the normal function and diseases of the digestive system, including the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts, and liver.

Function of B-cells and T-cells

B-cells and T-cells work together. When a T-cell recognizes an antigen, it will produce chemicals known as cytokines that cause B-cells to multiply and release many immune proteins (antibodies). Circulating widely in the bloodstream, antibodies recognize foreign particles and trigger inflammation to help the body rid itself of the virus or bacteria.

B-cells and T-cells play a vital role in protecting the immune system.

Flares

Fibromyalgia

Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as

Headaches

Sleep disturbances

Cognitive problems with thinking and memory (sometimes called "fibro fog")

Fibroblast

A fibroblast is the most common type of cell found in connective tissue. Fibroblasts secrete collagen proteins that are used to maintain a structural framework for many tissues. They also play an important role in healing wounds.

Fever

A fever is a body temperature that is higher than normal. It is not an illness. It is part of the body's defense against infection. Most bacteria and viruses that cause infections do well at the body's normal temperature (98.6 F). A slight fever can make it harder for them to survive. Fever also activates the body's immune system.

Fevers can be caused by autoimmunte disorders. Most people with SLE have fevers. Fever is defined as a temperature over 100°F (37.8°C). Fever related to active lupus usually responds to nonsteroidal antiinflammatory drugs (NSAIDs) (eg, naproxen, ibuprofen) and/or acetaminophen.

FDA

The FDA (or Food and Drug Administration) is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments. The FDA is responsible for protecting and promoting public health through the regulation and supervision of food safety, tobacco products, dietary supplements, prescription and over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices (ERED), and veterinary products.

Fatigue

Fatigue is different from drowsiness. Drowsiness is feeling the need to sleep. Fatigue is a lack of energy and motivation. Drowsiness and apathy (a feeling of not caring about what happens) can be symptoms that go along with fatigue. Fatigue can be a normal and important response to physical activity, emotional stress, boredom, or lack of sleep. Fatigue is a common symptom, and it is usually not due to a serious disease. But it can be a sign of a more serious mental or physical condition. When fatigue is not relieved by enough sleep, good nutrition, or a low-stress environment, it should be evaluated by your doctor.

Factorial Design

Describes a clinical study in which groups of participants receive one of several combinations of interventions. For example, a two-by-two factorial design involves four groups of participants. Each group receives one of the following pairs of interventions: 1) drug A and drug B, 2) drug A and a placebo, 3) a placebo and drug B, or 4) a placebo and a placebo. So during the trial, all possible combinations of the two drugs (A and B) and placebos are given to different groups of participants.

Extractable Nuclear Antibody (ENA) panel

The ENA panel is usually ordered following a positive ANA test for people who have signs and symptoms of an autoimmune disorder.

The 4-test ENA panel is used to help diagnose mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), and Sjögren syndrome. The 6-test ENA panel can also help identify scleroderma and polymyositis/dermatomyositis.

The pattern of positive and negative results obtained with an ENA panel is evaluated in conjunction with a person's clinical findings. If someone has symptoms that suggest a specific autoimmune disorder and the corresponding ENA autoantibody is positive, then it is likely that the person has that condition.

Extracellular Matrix (ECM) proteins

The complex extracellular matrix (ECM) surrounds and supports cells. In mammalian tissues the ECM is most commonly found in connective tissues such as tendon, cartilage, bone or dermis of the skin. Structural ECM proteins consist primarily of the collagen and elastin families of proteins. Collagen fibers strengthen and organize the matrix; elastin fibers provide flexibility and resilience. Nonstructural ECM proteins, such as fibronectin, laminin, and tenascin, serve more of an adhesive or integral role; these proteins allow for cell attachment and form crosslinks within the matrix gel. Finally, numerous proteoglycans and heparan sulfate-containing proteins form the hydrated, gel-like mixture that stabilizes the matrix within its aqueous environment.

Exclusion Criteria

Ex Vivo

Means that which takes place outside an organism. In science, ex vivo refers to experimentation or measurements done in or on tissue from an organism in an external environment with the minimum alteration of natural conditions. Ex vivo conditions allow experimentation on an organisms cells or tissue under more controlled conditions than is possible in in vivo experiments (in the intact organism), at the expense of altering the "natural" environment.

Examples of ex vivo specimen use include: assays; realistic models for surgical procedure development; investigations into the interaction of different energy types with tissues;

Etiology

Erythrocyte sedimentation rate (ESR or sed rate) test

The erythrocyte sedimentation rate blood test measures how quickly red blood cells (erythrocytes) settle in a test tube in one hour. The more red cells that fall to the bottom of the test tube in one hour, the higher the sedimentation rate.

When inflammation is present in the body, certain proteins cause red blood cells to stick together and fall more quickly than normal to the bottom of the tube. These proteins are produced by the liver and the immune system under many abnormal conditions, such as an infection, an autoimmune disease, or cancer.

Erythema

Epidemiology

Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. Various methods can be used to carry out epidemiological investigations: surveillance and descriptive studies can be used to study distribution; analytical studies are used to study determinants.

Eosinophils

Eosinophils are specialized white blood cells that participate in inflammatory processes such as allergic diseases. They also are involved in tissue repair and remodeling.

In healthy people, eosinophils comprise approximately 1 to 6 percent of white blood cells. The body may produce more of these cells in response to parasitic and fungal infections. Certain allergic diseases, skin conditions, autoimmune disorders, cancers, and bone marrow diseases also may result in elevated eosinophil counts. Many people with eosinophilic disorders have high numbers of eosinophils in their blood or tissues over a long period of time. Sometimes, the presence of excess eosinophils in tissue, called “eosinophilic inflammation,” can result in tissue damage.​​

Enrollment

Enrolling by Invitation

A clinical study that selects its participants from a population, or group of people, decided on in advance by the researchers. These studies are not open to everyone who meets the eligibility criteria, but only to people in that particular population, who are specifically invited to participate.

Eligibility Criteria

The key standards that people who want to participate in a clinical study must meet or the characteristics that they must have. These include inclusion criteria and exclusion criteria. For example, a study might only accept participants who are above or below certain ages.

Electrolytes

Electrolytes are minerals in your body that have an electric charge. They are in your blood, urine and body fluids. Maintaining the right balance of electrolytes helps your body's blood chemistry, muscle action and other processes. Sodium, calcium, potassium, chlorine, phosphate and magnesium are all electrolytes. You get them from the foods you eat and the fluids you drink.

Levels of electrolytes in your body can become too low or too high. That can happen when the amount of water in your body changes, causing dehydration or overhydration. Causes include some medicines, vomiting, diarrhea, sweating or kidney problems, such as lupus nephritis. Problems most often occur with levels of sodium, potassium or calcium.

Drug-Induced Lupus (DIL)

Drug-induced lupus (DIL) is an autoimmune disorder similar to systemic lupus erythematosus (SLE). As with SLE, the body mistakenly attacks healthy tissue. DIL is caused by an overreaction to a medication.

People with DIL may have symptoms that affect the joints, heart, and lungs. Lupus nephritis and other symptoms associated with SLE are rare in people with DIL.

Once the medication that caused DIL is stopped, symptoms may go away over time. Treatment usually involves nonsteroidal anti-inflammatory drugs, corticosteroids, or antimalarial drugs.

Diuretic

Diuretics are sometimes called “water pills” because they increase the rate of the body’s urine output. They are prescribed to treat congestive heart failure, high blood pressure, edema (water retention), and certain kinds of kidney or liver disease.

For lupus patients, diuretics are used to treat nephritis, or inflammation of the kidneys.

Discoid rash

Discoid lupus

Discoid lupus is the most common manifestation of the skin disorder chronic cutaneous lupus. It is characterized characterized by red, inflamed disc-like patches that have a scaling, crusty appearance. Discoid lupus usually occurs on the scalp, face, and neck. The condition can strike at any age among people of all ethnic groups.

Discoid lupus lesions can be induced or exacerbated by exposure to the sun. Early diagnosis and treatment and precautionary measures greatly improve outcomes. Untreated, discoid lupus can lead to scarring and permanent hair loss.

Dermatomyositis

Dermatomyositis is a progressive connective tissue disorder characterized by inflammatory and degenerative changes of the muscles and skin.

Muscle abnormalities may begin with aches and weakness of the muscles of the trunk, upper arms, hips, and thighs (proximal muscles). Muscles may be stiff, sore, and tender and, eventually, show signs of degeneration (atrophy). Affected individuals may experience difficulty in performing certain functions, such as raising their arms and/or climbing stairs. In addition, affected individuals may experience speech and swallowing difficulties.

Skin abnormalities associated with dermatomyositis often include a distinctive reddish-purple rash (heliotrope rash) on the upper eyelids, across the cheeks and bridge of the nose in a "butterfly" distribution, the forehead, or additional skin regions; scaling and degenerative (atrophic) changes of affected skin on the extending surfaces of the knuckles, elbows, knees, and/or other regions (Gottron's sign); an abnormal accumulation of fluid (edema) in body tissues surrounding the eyes; and/or other features.

Dermatologist

Depression

Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.

Major depression—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.

Persistent depressive disorder—depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.

People with a chronic illness such as lupus are at higher risk of depression. Studies show that as many as 60% of people with a chronic illness will have depression at some point in their lives.

Dendritic cells

Dendritic cells play a critical role in the regulation of the immune response in humans. They are antigen-presenting cells, meaning that their main function is to process antigen material and present it on the surface of other cells of the immune system.

These cells can be found in tissue that is exposed to the external environment, such as skin, the inner lining of the nose, lungs, stomach, and intestines.

The part that dendritic cells play in the manifestation of lupus is uncertain, which is why the ALR has funded several studies to grasp a better understanding of how these cells work.

Decorin

Decorin is a protein coded for by the DCN gene. This protein is a component of the extracellular matrix, which is the intricate lattice of proteins and other molecules that forms in the spaces between cells. Decorin is found in the extracellular matrix of a variety of connective tissues, including skin, tendon, bone, and cartilage. Connective tissues support the body's joints and organs.

Decorin is involved in the organization of proteins called collagens. Collagens strengthen and support connective tissues throughout the body. Collagens also play an important role in the cornea, which is the clear outer covering of the eye. Bundles of collagen called fibrils must be strictly organized for the cornea to be transparent. Decorin ensures that these collagen fibrils are uniformly sized and regularly spaced.

Data Monitoring Committee (DMC)

A group of independent scientists who monitor the safety and scientific integrity of a clinical trial. The group can recommend to the study sponsor that the study be stopped if it is not effective, if it is causing harm to participants, or if it is not likely to serve its scientific purpose. Committee members are chosen based on the scientific skills and knowledge needed to monitor the particular study. Also referred to as a data safety and monitoring board (DSMB).

Cytokines

Cyclophosphamide

Cyclophosphamide is an immunosupressive medication used to treat cancer, severe SLE and lupus nephritis. In lupus, cyclophosphamide is used when other drugs prove ineffective or are too invasive. However, cyclophosphamide can cause an adverse drug reactions.

Cutaneous lupus erythematosus

Cutaneous lupus eruthematosus is the type of lupus that affects the skin, which may lead to eruptions of hives and lesions. There are three lupus-specific lesions and non-specific lesions — and cutaneous lupus may be divided into three categories: chronic cutaneous lupus (CCLE), subacute cutaneous lupus (SCLE) and acute cutaneous lupus (ACLE). All three subsets are aggravated by exposure to sunlight.

Chronic cutaneous lupus (CCLE): The most common form of CCLE is discoid lupus. It is a painful chronic skin condition characterized by red, inflamed disc-like patches that have a scaling, crusty appearance. Discoid lupus usually occurs on the scalp, face, and neck. The condition can strike at any age among people of all ethnic groups.Discoid lupus lesions can be induced or exacerbated by exposure to the sun. Early diagnosis and treatment and precautionary measures greatly improve outcomes. Untreated, discoid lupus can lead to scarring and permanent hair loss.

Sub-acute cutaneous lupus erythematosus (SCLE): Characterized by lesions that appear on parts of the body that are exposed to sun, SCLE makes up approximately 10 percent of all lupus cases. Lesions from SCLE do not cause permanent scarring.

Acute cutaneous lupus (ACLE): This skin condition occurs when lupus is active and is generally characterized by rash and lesions. Often localized across the bridge of the nose and spreading to both sides of the face, it appears in a butterfly pattern.But ACLE is not restricted to the face. It can appear on other parts of the body, as well. ACLE usually occurs as a result of exposure to ultraviolet light.

Cutaneous

CRP (C-Reactive Protein)

CRP is a blood protein that is produced by the liver. High levels of CRP are caused by inflammation and infections. Levels of CRP can dramatically elevate in a period of hours and are usually present in people with SLE. Measuring the amount of CRP in the body is a screen for infectious and inflammatory diseases like lupus.

Crossover Design

Describes a clinical trial in which groups of participants receive two or more interventions in a particular order. For example, a two-by-two crossover design involves two groups of participants. One group receives drug A during the initial phase of the trial, followed by drug B during a later phase. The other group receives drug B during the initial phase, followed by drug A during a later phase. So during the study, participants "cross over" to the other drug. All participants receive drug A and drug B at some point during the study, but in a different order, depending on the group to which they are assigned.

CREST syndrome

The symptoms involved in CREST syndrome are associated with the generalized form of the disease Systemic sclerosis (scleroderma). CREST is an acronym for the clinical features that are seen in a patient with this disease. The “C” stands for calcinosis, where calcium deposits form under the skin on the fingers or other areas of the body. The “R”, stands for Raynaud’s phenomenon, spasm of blood vessels in the fingers or toes in response to cold or stress. The “E” represents esophageal dysmotility, which can cause difficulty in swallowing. The “S” is for sclerodactyly, tightening of the skin causing the fingers to bend. Finally, the letter “T” is for telangiectasia, dilated vessels on the skin of the fingers, face, or inside of the mouth.

Creatinine

Creatinine is a chemical waste product of creatine. Creatine is a chemical made by the body and is used to supply energy mainly to muscles.

A blood test that measures the level of creatinine in the blood is used to test kidney function. Creatinine is removed from the body entirely by the kidneys. If kidney function is not normal, creatinine level increases in your blood. This is because less creatinine is released through your urine.

Corticosteroids

Corticosteroids are drugs that closely resemble cortisol, a hormone that is naturally produced in the adrenal glands.

In one of the most common treatments for lupus, corticosteroids—or steroids as they are more commonly termed—are used to reduce the production of inflammation and reduce the activity of the immune system in order to minimize tissue damage. A physician’s decision to prescribe steroids is based on the potential benefits and risks, which vary from patient to patient.

Coronary artery disease (CAD)

CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.

Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

People with lupus have a higher risk of CAD. This is partly because people with lupus have more CAD risk factors, which may include high blood pressure, high cholesterol, and type 2 diabetes. The inflammation that accompanies lupus also increases the risk of developing CAD. People with lupus are often less active because of fatigue, joint problems, and/or muscle pain, and this also puts them at risk.

Heart disease is the number one killer of all women, but women with lupus are 50 times more likely to have chest pain or a heart attack than other women of the same age.

Controlled Trial

A type of clinical trial in which observations made during the trial are compared to a standard (called the control). The control may be observations from a group of participants in the same trial or observations from outside the trial (for example, from an earlier trial, called a "historical control").

Connective tissue

Connective tissue is the material inside your body that supports many of its parts. It is the "cellular glue" that gives your tissues their shape and helps keep them strong. It also helps some of your tissues do their work. Cartilage and fat are examples of connective tissue.

There are over 200 disorders that impact connective tissue. Some, like cellulitis, are the result of an infection. Injuries can cause connective tissue disorders, such as scars. Others, such as Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta, are genetic. Still others, like scleroderma, have no known cause. Each disorder has its own symptoms and needs different treatment.

Completed

Complete blood count (CBC) test

The complete blood count (CBC) is a screening test, used to diagnose and manage numerous diseases. It can reflect problems with fluid volume (such as dehydration) or loss of blood. It can show abnormalities in the production, life span, and destruction of blood cells. It can reflect acute or chronic infection, allergies, and problems with clotting.

Complement

The complement system is made up of about 25 proteins that work together to assist, or “complement,” the action of antibodies in destroying bacteria. Complement also helps to rid the body of antibody-coated antigens (antigen-antibody complexes).

Complement proteins, which cause blood vessels to become dilated and then leaky, contribute to the redness, warmth, swelling, pain, and loss of function that characterize an inflammatory response.

Comorbidity

In medicine, comorbidity is the presence of one or more additional disorders (or diseases)co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder.

Collagen

Collagen is the major insoluble fibrous protein in the extracellular matrix and in connective tissue. In fact, it is the single most abundant protein in the animal kingdom. There are at least 16 types of collagen, but 80 – 90 percent of the collagen in the body consists of types I, II, and III (Table 22-3). These collagen molecules pack together to form long thin fibrils of similar structure. Type IV, in contrast, forms a two-dimensional reticulum; several other types associate with fibril-type collagens, linking them to each other or to other matrix components. At one time it was thought that all collagens were secreted by fibroblasts in connective tissue, but we now know that numerous epithelial cells make certain types of collagens. The various collagens and the structures they form all serve the same purpose, to help tissues withstand stretching.

Cohort

Cognitive impairment

Cognitive impairment is defined as any difficulty with normal thought functions or processes, such as thinking, learning, or remembering.

Cognitive impairment can occur as a neurological symptom of lupus. However, cognitive impairment is a common occurrence that happens to everyone at some time, not just lupus patients, and it can affect one single thought process or many thought processes either temporarily or permanently.

Cognition

Closed Study

Clinical studies that are no longer recruiting participants because they have enough participants already, because they are completed, or because they have been stopped for some reason. This also describes studies with very specific eligibility criteria that recruit participants by invitation only. Recruitment statuses for closed studies appear in red text in ClinicalTrials.gov search results and study records.

Clinical trial

A clinical trial is a prospective biomedical or behavioral research study of human subjects that is designed to answer specific questions about biomedical or behavioral interventions (drugs, treatments, devices, or new ways of using known drugs, treatments, or devices). Clinical trials are used to determine whether new biomedical or behavioral interventions are safe, efficacious, and effective.

Clinical study

A research study using human subjects to evaluate the effect of interventions or exposures on biomedical or health-related outcomes. Two types of clinical studies are interventional studies (or clinical trials) and observational studies.

Clinical Immunology

Clinical immunology is the study of diseases caused by disorders of the immune system (failure, aberrant action, and malignant growth of the cellular elements of the system). It also involves diseases of other systems, where immune reactions play a part in the pathology and clinical features.

Chronic Pain

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). A person may have two or more co-existing chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do ordinary daily activities.

The main symptom of CFS is severe fatigue that lasts for 6 months or more. You also have at least four of these other symptoms:

Chronic disease

Chronic diseases are noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely.

Although chronic diseases are more common among older adults, they affect people of all ages and are now recognized as a leading health concern of the nation. Growing evidence indicates that a comprehensive approach to prevention can save tremendous costs and needless suffering.

Chronic Cutaneous Lupus (CCLE)

Chronic cutaneous lupus (CCLE) is one of three subsets of the general lupus skin disorder called cutaneous lupus erythematosus.

The most common type of CCLE is discoid lupus, a painful chronic skin condition characterized by red, inflamed disc-like patches that have a scaling, crusty appearance. Discoid lupus usually occurs on the scalp, face, and neck. The condition can strike at all ages and among all ethnic groups.

Chronic

Chromosomes

Chromosomes are thread-like structures located inside the nucleus of animal and plant cells. Each chromosome is made of protein and a single molecule of deoxyribonucleic acid (DNA). Passed from parents to offspring, DNA contains the specific instructions that make each type of living creature unique.

Chondrocalcinosis

Chondrocalcinosis is a condition characterized by deposits of calcium pyrophosphate dihydrate (CPPD) crystals in one or more joints that eventually results in damage to the affected joints. It most often affects the knee, wrist and pubic symphysis, the joint between the pubic bones in the front of the pelvis.

Chilblains (Perniosis)

Chilblains, also known as Perniosis, is an inflammatory disorder that is seen most often in young people who have Raynaud's phenomenon and people who are exposed to damp, cold weather. It is a form of inflammation of the small blood vessels (vasculitis) and is characterized by painful, itchy, tender, skin lesions on the lower legs, hands, toes, feet, ears and face. The lesions usually last for two to three weeks. One form of the disorder affects the blood vessels of the thighs.

Chemokines

Chemokines are low-molecular-weight proteins that stimulate recruitment of leukocytes. They are secondary pro-inflammatory mediators that are induced by primary pro-inflammatory mediators such as interleukin-1 (IL-1) or tumor necrosis factor (TNF). The physiologic importance of this family of mediators is derived from their specificity. Unlike the classic leukocyte chemo-attractants, which have little specificity, members of the chemokine family induce recruitment of well-defined leukocyte subsets. Thus, chemokine expression can account for the presence of different types of leukocytes observed in various normal or pathologic states.

Certain Agreements

As required by Section 801 of the Food and Drug Administration Amendments Act, in general, a description of any agreement between the sponsor of a clinical study and the principal investigator (PI) that does not allow the PI to discuss the results of the study or to publish the study results in a scientific or academic journal after the trial is completed. (This does not apply if the PI is an employee of the sponsor.)

Central Nervous System (CNS)

The central nervous system is made up of the brain and spinal cord. The brain functions to receive nerve impulses from the spinal cord and cranial nerves. The spinal cord contains the nerves that carry messages between the brain and the body.

Cellular Metabolism

A cell's daily operations are accomplished through the biochemical reactions that take place within the cell. Reactions are turned on and off or sped up and slowed down according to the cell's immediate needs and overall functions. At any given time, the numerous pathways involved in building up and breaking down cellular components must be monitored and balanced in a coordinated fashion. To achieve this goal, cells organize reactions into various enzyme-powered pathways.

Cell Culture

In its simplest form, cell culture involves the dispersal of cells in an artificial environment composed of nutrient solutions, a suitable surface to support the growth of cells, and ideal conditions of temperature, humidity, and gaseous atmosphere. In such a system, a researcher can precisely measure the response of the cell’s alterations in culture alterations, prospective drugs, the presence or absence of other kinds of cells, carcinogenic agents, and viruses.

Cell

Cells are the basic building blocks of all living things. The human body is composed of trillions of cells. They provide structure for the body, take in nutrients from food, convert those nutrients into energy, and carry out specialized functions. Cells also contain the body’s hereditary material and can make copies of themselves.

When someone has lupus, the immune system can't tell the difference between the body's healthy cells and bacteria and viruses, so the antibodies attack the body's healthy cells.

Cartilage

Cartilage is a type of hard, thick, slippery tissue that coats the ends of bones where they meet with other bones to form a joint. Cartilage lines the joint space between bones throughout the body, including the spine and the rib cage. It acts as a protective cushion between bones to absorb the stress applied to joints during movement.

Carotid plaque

A carotid artery on each side of the neck supplies blood to the brain. Carotid artery disease occurs when a substance called plaque builds up in either or both arteries. The buildup can narrow the artery and reduce the blood flow to your brain. This can raise your chance of a stroke or transient ischemic attack (TIA).

The narrowing in an artery is called stenosis. The more narrow an artery becomes, the greater the risk of stroke or TIA.

People who have lupus (systemic lupus erythematosus, or SLE) are at a higher risk for plaque deposits in arteries (atherosclerosis), and they develop these deposits at a younger age.

Cardiologist

Cardiac Tamponade

Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium). This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from working properly. As a result, the body does not get enough blood.

Cardiac tamponade is an emergency condition that needs to be treated in the hospital; the fluid around the heart must be drained as quickly as possible.

Butterfly rash

Butterfly rash is a red flat facial rash involving the malar region bilaterally and the bridge of the nose. The presence of a butterfly rash is generally a sign of lupus erythematosus (LE), but it can also include a plethora of conditions.

Bursa

A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving body parts such as muscles, tendons, or skin. Bursae are found throughout the body. Bursitis occurs when a bursa becomes swollen.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Blood Urea Nitrogen (BUN)

Blood chemistry test

Basic blood chemistry tests measure the levels of certain electrolytes, such as sodium and potassium, in the blood. Doctors typically order them to look for any sign of kidney dysfunction, diabetes, metabolic disorders, and tissue damage.

Biopsy

A biopsy is a procedure that removes a small piece of living tissue from your body. The tissue is examined with a microscope for signs of damage or disease. Biopsies can be done on all parts of the body. A biopsy is the only test that can tell for sure if a suspicious area is cancer. But biopsies are performed for many other reasons too.

There are different ways to do a biopsy. A needle biopsy removes tissue with a needle passed through your skin to the site of the problem. Other kinds of biopsies require surgery.

Biomarkers

Biomarkers are essentially proteins, enzymes, or other molecules in the body that can be used as tracers of diagnosis or indicators of disease activity. In the case of lupus, immune cells that are either more common in —or exclusive to — patients with lupus produce biomarkers.

Today, scientists are looking to at biomarkers as early predictors of lupus flares. Biomarkers also hold the promise of enhancing diagnostic accuracy, prognosis, and monitoring of treatment response.

Biological Pathway

A biological pathway is a series of actions among molecules in a cell that leads to a certain product or a change in a cell. Such a pathway can trigger the assembly of new molecules, such as a fat or protein. Pathways can also turn genes on and off, or spur a cell to move.

Biologic

Belimumab (Benlysta)

Belimumab, commonly known as Benlysta, is the first new drug therapy for lupus to be approved by the FDA in more than 50 years. Belimumab is a human antibody that inhibits B-cell activating factor (BAFF).

Significant decreases in the number of activated B cells have been observed in some patients. However, in testing, the drug was not effective with all types of lupus and showed little benefit among African Americans. More testing is planned for the more severe cases of lupus, including people with kidney and brain damage. Belimumab holds the promise of reduced disease manifestation and the sparing use of corticosteroid.

Baseline characteristics

Data collected at the beginning of a clinical study for all participants and for each arm or comparison group. These data include demographics, such as age and gender, and study-specific measures (for example, systolic blood pressure, prior antidepressant treatment).

Bacteria

Bacteria are living things that have only one cell. Under a microscope, they look like balls, rods, or spirals. They are so small that a line of 1,000 could fit across a pencil eraser. Most bacteria won't hurt you - less than 1 percent of the different types make people sick. Many are helpful. Some bacteria help to digest food, destroy disease-causing cells, and give the body needed vitamins. Bacteria are also used in making healthy foods like yogurt and cheese.

But infectious bacteria can make you ill. They reproduce quickly in your body. Many give off chemicals called toxins, which can damage tissue and make you sick. Examples of bacteria that cause infections include Streptococcus, Staphylococcus, and E. coli.

Antibiotics are the usual treatment. When you take antibiotics, follow the directions carefully. Each time you take antibiotics, you increase the chances that bacteria in your body will learn to resist them. Later, you could get or spread an infection that those antibiotics cannot cure.

B cells

Like T cells, B cells are a type of blood cell that belong to a group of white blood cells (WBCs) called lymphocytes, which help the body fight infection.When B cells encounter an antigen (infection or a foreign body), they become activated and produce molecules called antibodies that attach to the surface of the infectious agent. These antibodies either kill the infection-causing organism or make it vulnerable to attack by other WBCs. This process guards the body against infection.

These vital cells are called B cells because they are created in bone marrow. Once matured, B cells are present in the blood and lymph nodes.

The function of B cells and T cells is vital to the immune system, allowing humans to ward off and better cope with often-hostile bacteria, viruses, and other foreign matter.

Autoreactive B cells

B cells are a type of white blood cell that helps the body fight infection. In lupus this process malfunctions, causing the immune system to attack healthy tissue. Therefore, B cells are essential for the development and pathogenesis of autoimmune disease.

Autoreactive B cells are generally considered to be the source of autoantibodies, causing the body to secrete pro-inflammatory cytokines.

Autoimmunity

Autoimmunity is the failure of an organism in recognizing its own constituent parts as self, which allows an immune response against its own cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease. Autoimmunity is often caused by a lack of germ development of a target body and as such the immune response acts against its own cells and tissues. Prominent examples include Celiac disease, diabetes mellitus type 1 (IDDM), Sarcoidosis, systemic lupus erythematosus (SLE), Sjögren's syndrome, Churg-Strauss Syndrome, Hashimoto's thyroiditis, Graves' disease, idiopathic thrombocytopenic purpura, Addison's Disease, rheumatoid arthritis (RA) and allergies. Autoimmune diseases are very often treated with steroids.

Autoimmune disease

An illness that occurs when the body tissues are attacked by its own immune system. The immune system is a complex organization within the body that is designed normally to "seek and destroy" invaders of the body, including infectious agents. Patients with autoimmune diseases frequently have unusual antibodies circulating in their blood that target their own body tissues.

Autoantibody

Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Assays

An assay is an investigative (analytic) procedure in laboratory medicine, pharmacology, environmental biology, and molecular biology for qualitatively assessing or quantitatively measuring the presence or amount or the functional activity of a target entity (the analyte) which can be a drug or biochemical substance or a cell in an organism or organic sample.

Aseptic meningitis

Aseptic meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. Unlike other forms of meningitis, aseptic meningitis is not caused by infection and cannot be spread person-to-person. Instead it can be caused by lupus, cancers, certain drugs, head injury, and brain surgery, among others.

Meningitis is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as

Articular Cartilage

Articular cartilage is the highly specialized connective tissue of diarthrodial joints. Its principal function is to provide a smooth, lubricated surface for articulation and to facilitate the transmission of loads with a low frictional coefficient. Articular cartilage is devoid of blood vessels, lymphatics, and nerves and is subject to a harsh biomechanical environment. Most important, articular cartilage has a limited capacity for intrinsic healing and repair. In this regard, the preservation and health of articular cartilage are paramount to joint health.

Arthritis

Arthritis is inflammation of one or more joints and it involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

Usually the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type.

Apoptosis

Apoptosis is the natural process of cell death, which is a normal function of the body. When cells die, the debris is cleared by macrophages, or white blood cells within tissues. In people with lupus, however, apoptosis may play a role in disease manifestation.

Lupus patients may not be able to effectively clear apoptotic cells, which can evoke the production of cytokines. The cytokines cause B-cells to release antibodies—and in lupus, antibodies mistakenly attack healthy tissue and organs.

Antiphospholipid antibodies

Antiphospholipid antibodies (APLAs) are a type of protein that usually helps the body ward off infection. However, in lupus, APLAs mistakenly attack phospholipids, which is a type of fat found in in all living cells, including blood and the lining of blood vessels.

Antinuclear antibodies (ANA)

Antinuclear antibodies are antibodies that target proteins within the nuclei of cells. In autoimmune diseases like lupus, antinuclear antibodies can signal the body to begin attacking itself.

Most people have autoantibodies, but the presence of large amounts of them may indicate an autoimmune disease. There is a test that measures pattern and amount of autoantibodies. More than 95 percent of people with lupus test positive.

Antimalarials

Antigen Processing

Antigen processing is an immunological process that prepares antigens for presentation to special cells of the immune system called T lymphocytes. It is considered to be a stage of antigen presentation pathways. This process involves two distinct pathways for processing of antigens from an organism's own (self) proteins or intracellular pathogens (e.g. viruses), or from phagocytosed pathogens (e.g. bacteria); subsequent presentation of these antigens on class I or class II MHC molecules is dependent on which pathway is used. Both MHC class I and II are required to bind antigen before they are stably expressed on a cell surface. MHC I antigen presentation typically (considering cross-presentation) involves the endogenous pathway of antigen processing, and MHC II antigen presentation involves the exogenous pathway of antigen processing. Cross-presentation involves parts of the exogenous and the endogenous pathways but ultimately involves the latter portion of the endogenous pathway (e.g. proteolysis of antigens for binding to MHC I molecules).

Antigen Presentation

Antigen presentation is a process in the body's immune system by which macrophages, dendritic cells and other cell types capture antigens and then enable their recognition by T-cells.

The basis of adaptive immunity lies in the capacity of immune cells to distinguish between the body's own cells and infectious pathogens. The host’s cells express “self” antigens that identify them as such. These antigens are different from those in bacteria ("non-self" antigens) or in virally infected host cells (“missing-self”). The ability of the adaptive immune system to survey for infection requires specialized pathways of enabling recognition of pathogen-derived antigens by T cells.

Antigen

In immunology, an antigen is a substance that evokes the production of one or more antibodies. Each antibody binds to a specific antigen by way of an interaction similar to the fit between a lock and a key. The substance may be from the external environment or formed within the body. The immune system will try to destroy or neutralize any antigen that is recognized as a foreign and potentially harmful invader. The term originally came from antibody generator[1][2] and was a molecule that binds specifically to an antibody, but the term now also refers to any molecule or molecular fragment that can be bound by a major histocompatibility complex (MHC) and presented to a T-cell receptor.[3] "Self" antigens are usually tolerated by the immune system, whereas "non-self" antigens can be identified as invaders and can be attacked by the immune system.

Anticoagulant

Anticoagulants are substances that hinder blood from clotting by suppressing coagulation. Among their many benefits, anticoagulants are used in preventing stroke and thrombosis (formation of a blood clot in the heart). They are also used in drawing blood and flushing catheters.

Anticoagulant therapy is used to treat lupus patients. About one-third of people with the disease have antibodies to molecules that make them susceptible to blood clots.

Antibody

Anti-SSB (Anti-La) antibodies

Antinuclear antibodies that seem to be specific to Sjögren’s Syndrome. Their presence is associated with long disease duration, earlier disease onset, parotid gland enlargement, systemic manifestations and also with hypergammaglobulinemia, rheumatoid factors and monoclonal type II cryoglobulins.

Anti-SSA (Anti-Ro) antibodies

Anti-SM

Anti-SM are antibodies closely associated with lupus. Nearly all individuals with anti-SM antibodies have lupus—but only 20 percent of people with lupus have these antibodies. Anti-SM is rarely found in people with other rheumatic diseases and its incidence in healthy individuals is less than 1 percent. The presence of anti-SM is an indication of systemic lupus and is a factor in diagnosing the disease.

Anti-RNP antibodies

Ribonucleprotein (RNP) is a protein that is structurally associated with DNA. Anti-RNP antibodies are autoantibodies that are associated with lupus and are detected in nearly 40 percent of lupus patients. Anti-RNP is also closely associated with mixed connective tissue disease (MCTD), which features signs and symptoms similar to those of lupus.

RNP is a factor in both lupus and MCTD, which leads to an abnormal immune reaction causing inflammation of and damage to various body parts and can affect joins, skin, kidneys, heart, lungs, blood vessels, and the brain.

Anti-Cardiolipin Antibodies (ACA)

Anti-cardiolipin antibodies (ACA) are antibodies that are present in autoimmune diseases like lupus to directly attack cardiolipin, a protein that is very common in the body. As the name implies, cardiolipin is found mostly in the heart, and secondly in skeletal muscles.

Much remains unclear about the presence of ACA. Possible risks for pathological conditions in patients with lupus include: thrombosis (clotting), fetal loss, and thrombocytopenia (low platelets) – yet, ACA are also present in individuals with no apparent ill effects. It appears that more research is needed to grasp a better understanding of this antibody.

Ankylosing spondylitis

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it may be difficult to breathe deeply.

Ankylosing spondylitis affects men more often than women. Signs and symptoms of ankylosing spondylitis typically begin in early adulthood. Inflammation also can occur in other parts of your body — most commonly, your eyes.

There is no cure for ankylosing spondylitis, but treatments can decrease your pain and lessen your symptoms.

Animal Models

Except in the case of highly controlled and regulated clinical trials, geneticists and scientists do not use humans for their experimental investigations because of the obvious risk to life. Instead, they use various animal, fungal, bacterial, and plant species as model organisms for their studies.

When animal models are employed in the study of human disease, they are frequently selected because of their similarity to humans in terms of genetics, anatomy, and physiology. Also, animal models are often preferable for experimental disease research because of their unlimited supply and ease of manipulation. For example, to obtain scientifically valid research, the conditions associated with an experiment must be closely controlled. This often means manipulating only one variable while keeping others constant, and then observing the consequences of that change. In addition, to test hypotheses about how a disease develops, an adequate number of subjects must be used to statistically test the results of the experiment. Therefore, scientists cannot conduct research on just one animal or human, and it is easier for scientists to use sufficiently large numbers of animals (rather than people) to attain significant results.

Angiogenesis

Angiogenesis is the growth of blood vessels from the existing vasculature. It occurs throughout life in both health and disease, beginning in utero and continuing on through old age. No metabolically active tissue in the body is more than a few hundred micrometers from a blood capillary, which is formed by the process of angiogenesis. Capillaries are needed in all tissues for diffusion exchange of nutrients and metabolites. Changes in metabolic activity lead to proportional changes in angiogenesis and, hence, proportional changes in capillarity. Oxygen plays a pivotal role in this regulation. Hemodynamic factors are critical for survival of vascular networks and for structural adaptations of vessel walls.

Analgesic

Analgesics, or pain relievers, are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.

AMP – Accelerating Medicines Partnership

The Accelerating Medicines Partnership (AMP) is a bold new venture between the NIH, 10 biopharmaceutical companies and several non-profit organizations to transform the current model for developing new diagnostics and treatments by jointly identifying and validating promising biological targets of disease. The ultimate goal is to increase the number of new diagnostics and therapies for patients and reduce the time and cost of developing them.

AMP will begin with three to five year pilot projects in three disease areas:

Aggrecan

Aggrecan is a type of protein known as a proteoglycan, which means it has several sugar molecules attached to it. It is the most abundant proteoglycan in cartilage, a tough, flexible tissue that makes up much of the skeleton during early development. Most cartilage is later converted to bone (a process called ossification), except for the cartilage that continues to cover and protect the ends of bones and is present in the nose, airways, and external ears.

Aggrecan attaches to the other components of cartilage, organizing the network of molecules that gives cartilage its strength. These interactions occur at a specific region of the aggrecan protein called the C-type lectin domain (CLD). Because of the attached sugars, aggrecan attracts water molecules and gives cartilage its gel-like structure. This feature enables the cartilage to resist compression, protecting bones and joints. Although its role is unclear, aggrecan affects bone development.

Adverse Event

An unfavorable change in the health of a participant, including abnormal laboratory findings, that happens during a clinical study or within a certain time period after the study is over. This may or may not be caused by the intervention being studied.

Adrenal glands

The adrenal glands are small glands located on top of each kidney. They produce hormones that you can't live without, including sex hormones and cortisol. Cortisol helps you respond to stress and has many other important functions.

Adapter Protein

A protein acts as a connecting molecule. An adapter protein is critical to intermolecular interactions and plays a role in the regulation of signal transduction initiated by engagement of surface receptors on all cell types. Some adapter proteins are expressed in all tissues, while the expression of other adapter proteins is restricted to specific tissues.

ADAP

The AIDS Drug Assistance Program (ADAP) provides free medications for the treatment of HIV/AIDS and opportunistic infections. The drugs provided through ADAP can help people with HIV/AIDS to live longer and treat the symptoms of HIV infection. ADAP can help people with partial insurance or who have a Medicaid spenddown requirement.

Acute Phase Reactants

Acute phase response is the sum of the systemic and metabolic changes occurred by release of acute phase proteins in response to inflammatory stimulus. The most important ones of these acute phase reactants are erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen and ferritin. The most widely used ones are ESR and CRP while fibrinogen and ferritin are rarely used and other acute phase reactants have no place in routine clinical use. Although ESR is clinically the most commonly used test, it is fairly nonspecific. Even though CRP is more specific than ESR, because of the high cost of the analysis it has clinically limited usage.

Acute Cutaneous Lupus (ACLE)

Acute cutaneous lupus (ACLE) is one of three subsets of the general lupus skin disorder called cutaneous lupus erythematosus.

This condition occurs when lupus is active and is generally characterized by rash and lesions, often localized across the face in a butterfly pattern. However, ACLE can appear on other parts of the body, as well. ACLE usually occurs as a result of exposure to ultraviolet light. Without predictability, symptoms may come and go and severity varies greatly from person to person.

ACR Criteria

The American College of Rheumatology (ACR) has a list of symptoms and other measures that doctors can use as a guide to decide if a patient with symptoms has lupus. If your doctor finds that you have at least four of these problems, and finds no other reason for them, you may have lupus:

Rashes:

butterfly-shaped rash over the cheeks — referred to as malar rash

red rash with raised round or oval patches — known as discoid rash

rash on skin exposed to the sun (photosensitivity)

Mouth sores: sores in the mouth or nose lasting from a few days to more than a month (oral ulcers)

Arthritis: tenderness and swelling lasting for a few weeks in two or more joints

Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeply

Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function

positive antinuclear antibody: referred to as ANA and present in nearly all patients with lupus

certain antibodies that show an immune system problem: anti-double-strand DNA (called anti-dsDNA), anti-Smith (referred to as anti-Sm) or antiphospholipid antibodies, or a false-positive blood test for syphilis (meaning you do not really have this infection)